A Day in the Life of a CE: Linda Snell

By Jamiu Busari (@jobusar)

Linda Snell (@lindasmeded)
Professor of Medicine and Core faculty member, McGill Centre for Medical Education
Senior Clinician Educator, Royal College of Physicians and Surgeons of Canada
Montreal, Canada

What is your clinical and/or educational background?

Linda Snell MD, MHPE, is a general internist, or consultant physician; she enjoys general internal medicine because the variety stimulates her, and the challenge of solving problems and dealing with uncertain diagnoses. She went to medical school at the University of Alberta in Edmonton and moved to Montreal in 1975. Although she intended to spend only a year expanding her horizons in Montreal, Linda loved the life there and ended up staying there to complete her residency in general internal medicine (GIM), finishing as a chief resident in 1980 and starting her practice at McGill. Part of her clinical life is devoted to inpatient and outpatient care, and initially she also practiced critical care.  Being a physician in an academic setting, Linda teaches residents and medical students. She thinks that teaching in all of these clinical settings is essential for her different roles as a clinician and clinician educator.  She believes GIM provides her with the opportunity to deal with ambiguous and complex issues, and in terms of thought processes, she recognizes the similarities between the practice of medicine and medical education.

Linda completed her MHPE in 1987 at the University of Illinois. Back then, there was no Internet and hence little opportunity for distance learning, so she commuted back and forth between Montreal and Chicago. The closest she got to distance learning was sending in her assignments by fax! She saw an advantage in commuting, in that she was able to be physically away from her clinical work and immerse herself in medical education.

Linda is currently a senior Clinician Educator at the Royal College where she focuses on faculty development and provides education expertise. For example, she co-authored the most recent CanMEDS framework with Jason Frank and Jonathan Sherbino. She is also responsible for co-leading (with Jason) the International Competency-based Medical Education Collaborators (ICBME) and the International Clinician-Educator network. She advises on faculty development around the competency-based education initiative for residents, and has developed and delivered international faculty development activities, currently mainly in Latin America. At McGill, she has held a number of education leadership roles, including Director of the GIM Residency Program, Director of Undergraduate Internal Medicine, Vice-Chair (Education) of the Department of Medicine, Associate Dean of Continuing Medical Education, and Director of the Medical Education Elective Program for students. In addition to being a Professor of Internal Medicine, Linda is currently the Co-director of the MHPE stream of the Masters of Education program at McGill University.

Linda says that she loved teaching even before she entered medical school: she taught swimming and tutored school classmates. She got involved in medical education very early in her career, as a medical student sitting on the curriculum committee, and as a resident and chief resident being involved in the teaching, organization, and leadership aspects of education. Upon starting her clinical practice, Linda realized how much she enjoyed her teaching role, and wanted to know more about the science behind what she did. She also realized that she needed an area of expertise as an academic, but there were no clinician educators role models then. She consulted her department chair to discuss her plans to do a degree in education. The response was “go and do something in laboratory medicine or basic science research instead!” This did not align with her views about the problems in medical education that needed to be addressed in a scholarly way. Luckily, she went to see her dean was very supportive: this was instrumental for her career as a clinician educator.  When Linda returned with her degree, she found that there was nobody to talk to or who understood what she was doing. Luckily, she met Robyn Tamblyn (who co-edited the book on Problem Based Learning) and discovered someone who ‘spoke the same language as an educator’ (she smiles). As well, after returning to McGill with a new master’s in health professions education, she was appointed to a number of educational roles including undergraduate program director, postgraduate program director and director of the faculty-wide CanMEDS programs for residents. “I have been privileged enough,” she says, “to have contributed to the development of the Center for Medical Education at McGill University and to various other educational programs nationally and internationally.”

Currently, Linda’s day-to-day work as an educator involves all the things that she, Jon Sherbino and Jason Frank had talked about when they defined ‘clinician educator’: someone who uses the theoretical basis of education to improve their educational practice, be it in teaching, curriculum planning or assessment, and who also is involved in education leadership and scholarship.

Linda’s educational leadership skills developed ‘on the job’: from learning (doing it), mentoring (getting tips and advice from peers and colleagues), experimenting (figuring out what works or doesn’t) and reflecting.

Lately, Linda has been musing about the fact that when involved in faculty development she has had to provide education about topics in domains where she was not an expert. “You almost become an expert” she says, “as in preparation for these courses you have to learn or teach yourself more about these topics to know enough to teach others.”

Linda thinks that the environment in McGill is favorable for young academics pursuing careers in medicine and medical education. As far as she knows, the center for medical education in McGill is one of the first centers that had many clinician educators as members, who work collaboratively with Ph.D. educators, with the expertise of each group informing the other.

What percentage of your time is spent for clinical practice, teaching activities, educational research, and administrative work?

Over her career, Linda has moved from devoting 100% of her time to clinical work to about a quarter to a third time now. There has been a proportionate increase in teaching and then the combination of leadership and educational scholarship. Currently, Dr. Snell spends about 30-40% of her time as a clinician and clinician-teacher, 30-40% in leadership and administration in medical education (including the work she does for the Royal College) and another 30-40% goes into educational scholarship (including supervising graduate students) and innovation.   Linda says that one of the things she has enjoyed about her career is “being the first person in a job whatever the job may be.” For example, she was the first program director in GIM, the person who founded the postgraduate core competencies program (like faculty development for residents) at McGill, and the person responsible for creating a master’s program in medical education. “To me those are the creative things. Moreover, you do not have to meet any expectations because no one else has done it before.”

How do you enjoy the diversity of your work/career?

Asked about what Linda enjoys most about her work, she responded “I love the diversity of my work. I think I would be bored doing the same thing all day, every day”. In her clinical life, Linda has thrived from having a variety of challenges and new things to do. Balancing clinical and nonclinical responsibilities is a challenge though because if there is an urgent problem clinically everything else (including teaching) will be “put on the back burner” until the clinical issue is dealt with. “One of the things I tell junior CEs is that as you get more ‘senior’ in the profession, with a little more control over your own time, you can decide to do a little bit less of one thing so that it leaves you with some extra time to do more in other areas.” However, she still has problems finding time to write and be creative. “One of the things I find helpful is to do something that has more than one purpose. So, if I am going to innovate, I try to write about it. For example, if I find something effective for my clinical teaching, I then try to examine it in a scholarly way. I try to be efficient by using opportunities more than once. It is still a challenge, there are only so many hours in a day, and frankly, you want to have time for your personal life and to keep well also.”

Do you experience difficulty with the diversity in your work? If yes, how do you handle it?

When asked about difficulties she has encountered due to the variety of her work, Linda says “I probably wouldn’t be in such situation in the first place if I had learned how to say no. I enjoy doing the things I do, and I tend to say yes to everything when I probably should have said no.”   Asked about other methods she uses to deal with some of the challenges she faces, Linda responds saying “my emergency medicine friends tell me that I am an honorary emergency medicine physician as I can focus on one thing for a short time, and immediately move on to the next thing at a very fast pace.”  She also has a close-knit community of colleagues who are friends and clinician educators with whom she chats regularly about the difficulties they all face in their work and how to approach things differently. In this peer network you can describe something and know that the other person understands and maybe has a slightly different approach. This she describes as “peer and near-peer” clinician educator teaching and learning.

Asked about her thoughts on the changes that have occurred in medical education and her role in this process as a senior CE, Linda responds saying “The more things change, the more they remain the same.” Things are always changing – from PBL 20-25 years ago to conversations about CBME, CBD, and EPAs nowadays. There is always something new, which in theory is better. “We would stagnate and become apathetic if there wasn’t something new, so I do not mind that” On reflection, however, she feels that what she sees as important now is probably different from what she saw as important when she started her career. “Twenty years ago, it was about creating a program and doing some innovative teaching, but now I think what I enjoy the most is developing the next generation of doctors with my medical teaching and making sure they are well-rounded clinicians, not just knowledgeable with nothing else. I also enjoy developing clinician educators and educational scholars, for example with the work I do in the master’s program and ICENET. To me, it is all about developing the next generation, one way or the other!”

Three tips for an aspiring CE

Here are three tips she Linda has for junior CEs:

  1. Recognize that there are only so many hours in a day, so make those hours count, for work, friends and self.
  2. Find a (virtual or physical) community of like-minded people for understanding, stimulation and support. And work with them or collaborate on cool projects that will move the field forward.
  3. Do something you are passionate about, and if you are doing things you are not passionate about, gently extricate yourself. When you get up in the morning, you should really want to go to work, knowing, that is the right thing for you.